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Insurance Matters and Financing

Insurance coverage varies for weight loss surgery procedures. It is crucial that you call your insurance provider to determine if your policy covers surgical weight loss. As an integral part of our team, a financial counselor can answer questions and give you guidance when working with your insurance company to acquire approval. It is a team effort between you and our financial counselor to ensure we do everything possible to gain an approval for surgical weight loss procedures such as laparoscopic gastric bypass surgery.

We understand the importance of surgical weight loss procedures and will work with you every step of the way. Should your insurance deny coverage, we will actively work with you to appeal the decision.

CCF has partnered with Bank of America to offer you an additional source for funds to help pay for elective surgical procedures or personal needs.

Click here to learn about Bank of America financing.

Cleveland Clinic accepts all major insurance carriers, including Medicare and Medicaid.

To contact our financial counselors about surgical weight loss procedures, call Debra Cash at 216-445-1745/800-223-2273, ext 51745 or by email at cashd@ccf.org or Tammy Hall at 216-636-0795/800-223-2273, ext 60795 or by email at hallt3@ccf.org.

Gaining Approval
Most insurance companies will require extensive documentation regarding your attempts to lose weight in the past as they determine whether or not to finance your surgical weight loss procedure. To be prepared, we ask that you gather the following information:

1. Medical documentation of a five-year weight history
2. Any actual documentation of diet drugs and medically supervised diets prescribed
3. Any commercial diet program records (Weight Watchers, Jenny Craig, etc.)
4. Any exercise program records (YMCA/YWCA, gym membership, etc.).

You will need to begin gathering these records NOW so that these are available when we communicate with your insurance company. It is NOT enough for you to simply list these items on the Health Questionnaire. The insurance company will require official documentation of attempts at weight loss.

If you have a weight history and weight treatment history at Cleveland Clinic, we will gather that weight information and the weight loss drugs prescribed by Clinic doctors from your Cleveland Clinic medical record. For weight history outside Cleveland Clinic or its satellite offices, you will need to contact the doctor who weighed you and/or prescribed weight loss drugs for a copy of that documentation. A summary letter of dates, weights, medications prescribed and supervised diets from that doctor is acceptable. You may need to contact commercial diet program offices and exercise facilities for records if you do not have these.

Acquiring Approval
Once your test results, consults, weight history, diet and exercise program documentation and other records have been received and reviewed by our office, we will submit a letter of recommendation to your insurance carrier requesting approval for the weight loss surgery procedure. Your medical records are forwarded to your insurance company with this letter. The insurance company will let us know if there is any additional information they will need to make the decision to approve or deny your weight loss surgery.

Some insurance companies will make the decision about your weight loss surgery within a few weeks. Some insurance carriers take several weeks or months to return a decision. We will contact you when we have heard from your insurance company. You may contact your insurance company to check on the status of your insurance approval.

If your insurance company denies the request for coverage of your weight loss surgery procedure, our financial counselor will discuss appeals and self-pay options with you.

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Insurance List

The insurance companies referenced are only a summarization of those accepted by Cleveland Clinic. This does not guarantee that you have bariatric coverage nor that you will be accepted into the bariatric program. In addition, we may accept other carriers not specifically identified. Please contact us directly to clarify any concerns.

Insurance Carrier	Contact Phone Number	Medically Supervised Diet	Diet History	Notes
Medical Mutual of Ohio	800-362-1279	6 MONTHS	2 YEARS
***GM Division	800-533-4755	6 MONTHS	2 YEARS
Aetna	888-632-3862	6 MONTHS- 3 CONSECUTIVE	NONE
Cigna	800-244-6224	6 MONTHS	NONE
Antares / CCHS (EHP ID #'s)	800-451-7929	NONE	1 YEAR	Patient needs to be under healthplan for 2 years prior to being eligible for surgery- also has to have BMI of 40 or greater for 1 year- pay surgical copay of $2750
Antares / CCHS ( EMH ID #'s)	800-451-7929	NONE	1 YEAR	Does not follow the 2 yr requirement - does not have copay req either- needs BMI of at least 40 for 1 year
United Healthcare	877-842-3210	6 MONTHS- or 2- 3 MONTH Programs	5 YEARS
Tricare	877-874-2273	PRIME PLANS- 6 MONTHS
Anthem BCBS	800-676-2583	NONE	5 YEARS
BCBS Federal	800-451-7602	NONE	NONE
BCBS GM Plans	800-345-4907	6 MONTHS
BCBS of Michigan	800-344-8525	6 MONTHS UNLESS BMI IS > OR = TO 50
Highmark BCBS	800-547-3627	6 MONTHS
Horizon BCBS- New Jersey	800-624-1110	6 MONTHS	NONE
BCBS of Illinois	800-541-2767	3 MONTHS	NONE
BCBS of Minnesota	800-531-6676	6 MONTHS	2 YEARS
BCBS of South Carolina	800-676-2583	NO
Empire BCBS	800-676-2583	NO	NONE
BCBS of Virginia	800-533-1120	NO	NONE
Excellus BCBS -Rochester, NY	800-676-2583	6 MONTHS	5 YEARS	No substance abuse for 6 months prior to surgery; 5% weight reduction from start of program till surgery request
BCBS of Western New York	800-676-2583	6 MONTHS
BCBS of Florida	800-676-2583	6 MONTHS
BCBS of Massachusettes	800-443-6657
BCBS of Tennessee	800-676-2583	NO	5 YEARS
Carefirst BCBS - Maryland	800-676-2583	6 MONTHS
BCBS of North Carolina	800-676-2583	NONE	2 YEARS
BCBS of Alabama	800-676-2583	6 MONTHS	3 YEARS	Must quit smoking at least 8 weeks prior to surgery
BCBS of Texas	877-235-9258	3 MONTHS	5 YEARS
Wellpoint	800-676-2583	NONE	NONE
BCBS of Georgia	800-676-2583	NONE	NONE
Independence BC	800-676-2583	NONE	NONE
Arkansas BCBS	800-676-2583	6 MONTHS	NONE
Mountain State BCBS	800-676-2583	6 MONTHS	NONE
Meritain Health		6 MONTHS or 2- 3 MONTH DIETS	5 YEARS	Cardiac Clearance
Chesterfield Resources		6 MONTHS	3 YEARS
Business Administrators & Consultants (MMO)	614-863-8780 or 800-521-8654	6 MONTHS
Employee Benefit Management (MMO)	877-304-0761	2 Yr Program- ACMS 800-831-6677
Benefit Services (MMO)	800-367-3762	6 MONTHS
Wells Fargo	800-428-1291
Central States	800-323-5000
Ohio Medicaid	800-686-1516	6 MONTHS
***Permedion (OH Medicaid)	800-772-2179
Caresource	800-488-0134	9 MONTHS
Wellcare	800-951-7719	6 MONTHS
SummaCare	330-996-8400			Needs referral
Humana	866-486-5295
Klais and Company	330-867-8443
Kaiser	216-623-8765			Needs referral
NALC	888-636-6252	6 MONTHS
Paramount	800-462-3589
ChampVa	800-733-8387
Univera Healthcare	800-628-8451
Aultra Administrators	800-325-8424
Aultcare	330-363-6360
Forum Health	330-726-5806
Principle Life Insurance (MMO)	800-533-5044	6 MONTHS
Advantra Freedom	866-386-2330
Ministry of Health				Prior Approval Application for Full Payment of Insured Out of Country Health Services must be completed by your primary care physician per Ontario Ministry of Health for your care to be paid for.

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Now that you have read about your insurance and financing options, click here to get started on your Pathway to Surgery.

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